A new tool will help screen for obstructive sleep apnea in people with epilepsy whose seizures the disorder can magnify, researchers say.

Although detection and treatment of obstructive sleep apnea (OSA) can improve seizure control in some patients, providers have not regularly assessed them for risk factors.

The new electronic health record alert will help neurologists evaluate a patient’s need for a sleep study to determine the necessity of treatment, which can improve seizure control, reduce the need for antiepileptic medication, and even reduce the risk of sudden unexpected death.

Complex relationship

OSA occurs when breathing is interrupted during sleep. The Epilepsy Foundation estimates that approximately 40 percent of people living with epilepsy have a higher prevalence of OSA that contributes to poor seizure control.

“Sleep disorders are common among people living with epilepsy and are underdiagnosed,” says lead author Martha A. Mulvey, a nurse practitioner in the neurosciences department at Rutgers University Hospital.

“Sleep and epilepsy have a complex reciprocal relationship. Seizures can often be triggered by low oxygen levels that occur during OSA. Sleep deprivation and the interruption of sleep can therefore increase seizure frequency,” Mulvey says.

As reported in Neurology Clinical Practice, the new assessment includes 12 recognized risk factors in the electronic health records. If a patient has at least two risk factors, the tool refers them for a sleep study.

The risk factors include:

Body mass index greater than 30 kg/m2

Snoring

Choking or gasping in sleep

Unexplained nighttime awakenings

Morning headaches

Dry mouth, sore throat, or chest tightness upon awakening

Undue nighttime urination

Decreased memory and concentration

Neck circumference greater than 17 inches

Excessive daytime sleepiness

Undersized or backward displacement of the jaw

Assessment of the distance from the tongue base to the roof of the mouth

Early detection

“It was found that placing this mandatory alert for providers to screen for OSA in the EHR markedly increased the detection of at-risk epilepsy patients who should be referred for a sleep study,” says coauthor Xue Ming, professor of neurology at Rutgers New Jersey Medical School.

“Such screening can lead to early detection and treatment, which will improve the quality of life of patients with epilepsy and OSA,” Ming says.

In cases that were reviewed prior to the alert being placed in the electronic health record, only 7 percent with epilepsy were referred for sleep studies. Of those who were referred, 56 percent were diagnosed with sleep apnea.

Of the 405 patients who received screening for OSA after the alert was placed in the electronic health record, 33 percent had at least two risk factors and were referred for a sleep study. Of the 82 patients who completed a sleep study, 87 percent showed at least mild sleep apnea.